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C O M P E T E N C I E S
Business Knowledge and SkillsAndrew N. Garman, Psy.D., associate professor and director of masters programs,
Department of Health Systems Management, Rush University, Chicago;Teresa Burkhart, senior director, Rush Health Associates, and assistant professor,
Department of Health Systems Management, Rush University; and
Jeremy Strong, administrator, Surgical Services, and instructor, Department
of Health Systems Management, Rush University
In our first installment, we discussed competencieswhat they are and why they
are importantand highlighted the work of the Healthcare Leadership Alliance
(HLA) in this area. In this installment, we explore the most technical of the five
HLA competencies: business knowledge and skills.
W H A T T H E B K S C O M P E T E N C I E S E N T A I L
The HLA defines business knowledge and skills (BKS) as the ability to apply
business principles, including systems thinking, to the health care environment.
In researching the BKS competency, the HLA found ten general areas relevant at
the broadest level: project management, organizational business and personal
ethics, facilities planning, purchasing procurement, evidence-based practice, inven-
tory control systems, proposal analysis and contract negotiation, critical thinking
and analysis, needs analysis for and/or desirability of outsourcing, and outcomes
management implementation. In addition, eight subdomains were found to be
particularly critical. Each of these subdomains is described below.
Financial management. This area includes knowledge related to a variety of financial
concepts, including financial analysis and planning methodologies, reimburse-
ments (i.e., rate setting and contracts), and financial outcomes measures. Skill areas
in this subdomain include analysis of reward versus risk, stewardship of resources,
development/use of monitoring systems, and application of financial planning to
organizational objectives.
Human resources. This area includes knowledge of the employment environment,
including staff safety and health as well as legal rights and protections of employ-
ees, and the methods for motivation and conflict resolution. A number of the
competency statements focus on understanding human resources systems, includ-
ing workforce planning, performance management, and management of diverse
environments.
Organizational dynamics and governance. This area encompasses an understanding of
how organizational systems are structured and governed as well as what factors
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within the system influence change and resistance to change. Skill areas related
to this domain include building trust between stakeholder groups; operating with
and evolving policies and procedures; and working creatively with departments
to find synergies, which presents opportunities for collaboration that optimize
organization-level performance.
Strategic planning and marketing. This area focuses on how knowledge of the market
is used to move the organization into the areas of greatest need and opportunity
and how the services of the organization are communicated to consumers. Knowl-
edge areas in this subdomain include business planning, competitive and market
data analysis, and crisis and disaster planning. Skill areas include anticipating
cause-effect relationships, developing organizational mission and vision, and align-
ing goals and objectives with this mission and vision.
Information management. This area covers the use of computer and software applica-
tions in the delivery of health services and enhancement of operational efficiency.
Knowledge areas include an understanding of information systems (health infor-
matics, information systems continuity, and planning and implementation cycles)
and specific applications (e-commerce, Internet, intranet, spreadsheets, and pro-
ductivity tools) and the appropriate analysis and interpretation of data. Relevant
skills in this area include ensuring staff are well equipped to avail themselves of
information systems and effectively integrating information technology plans into
the broader business plans.
Risk management. This area focuses on the reality that all services involve some
measure of risk and that effective management of that risk is essential to organi-
zational effectiveness. Knowledge areas include liability; compliance; methods for
mitigating risk (e.g., insurance, disaster recovery); malpractice; disaster planning;
and the relationship of risk management to personnel law, quality management,
and safety.
Quality improvement. This area covers the methods by which systems can be mon-
itored and continuously improved, including an understanding of the variety ofquality theories, methods, and analytic tools available.
Systems thinking. Given the importance of understanding the organization as an
interrelated whole, this area was broken out as a BKS domain unto itself. This do-
main includes an understanding of the impacts and consequences of decisions on
internal and external stakeholders and establishing coalitions across departments to
address big-picture development opportunities.
H O W O R G A N I Z A T I O N S C A N U S E T H E B K S C O M P E T E N C I E SApplications of this competency area are particularly relevant to first-level manage-
ment positions. Many managers in healthcare reached their leadership positions
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by virtue of their outstanding performance at the line level. Their promotion may
have been given without much opportunity for commensurate training, leaving
the promoted individual to learn the job as he or she goes. On-the-job experi-
ence (coupled with accurate and timely feedback) may be the best way to learn a
management role, but this process can unfold somewhat haphazardly. Often, thislearning is the result of responding to presented need rather than as a planned,
proactive effort to gain adequate exposure to all aspects of the new managers
accountability.
The BKS competency model can be an effective tool in moving an organization
from having a reactive approach to a proactive approach. For example, the compe-
tency list may be woven into the new-manager orientation checklist; each domain
can be mapped up as part of a plan to expose and/or develop the new manager
in a particular area. Similarly, each area may be used as part of development plan-
ning early in the transition process. An example of such a planning document isprovided in Table 1.
W H A T L E A D E R S S H O U L D K E E P I N M I N D
A B O U T T H E B K S C O M P E T E N C I E S
As we considered the BKS areas individually in terms of our experience with de-
veloping new managers for operational roles, we came up with several key themes
common across these areas.
Learning by doing. The very nature of management work involves engaging organi-zational systems to develop approaches that work in areas that are not doing well.
With experience comes a greater fund of approaches or solutions from which to
draw as well as a recognition of opportunities that can be pursued.
Understanding the importance of context. Textbooks, graduate courses, and even early
experiences tend to cause managers to fall into the trap of thinking that there is
only one right way to doing things. In reality, every organization has its own
unique processes. The challenge is in understanding the reasoning behind those
processes so that the manager knows when to go with the flow and when to drivefor change.
Knowing limits, and understanding others limits. There are many domain experts in the
BKS competency. For human resources and risk management areas, in particular,
managers are well-served to err on the side of asking professionals in these depart-
ments the silly questions. In addition to serving as a preventive measure, asking
questions is a useful educational process in and of itself.
The flipside of this idea is also true: healthcare managers often fail to recognize
how much of their own education is unique to them. Professionals in informationservices, health law, human resources, and other areas relevant to BKS may have
much less contextual knowledge of how health systems work; a number of them
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TABLE
1
Example
:BKSCompetenciesinaNew-ManagerOrientationChecklist
Name:
Supervisor:
Position:
Compe
tency
DevelopmentNeed
Plan
TargetDate
Review
Date
Human
resources
Understandingof
employeeperforma
nce
management
Bytheendofthemonth,
youwill(1)readHRpoliciesand
proceduresand(2)attendtheemployeerelationsd
evelopment
planwritingworksho
p.
Afterthis,
Iwillillustrateth
edisciplinary
processbydiscussingatleastthreecasestudiesbasedonprior
employees.
Wewillth
enmeetatleastweeklytodisc
usscurrent
employees.
Feb28
Financ
ial
manag
ement
Exposuretocost
monitoringand
budgetingprocesses
Iwillgoovermonthlycost-variancereportswithyouthismonth.
Overthenextseveralmonths,youwillreviewthese
andprovideme
withasummaryofwhereyouhavequestions.
June30
Quality
improvement
Understanding
of/participationin
CQI
process
YouwilljoinmeonthepatientexperienceQIteam.
Wewillwork
togetheroverthenext
severalmonthsonthegreete
rproject,
soyoucangetasense
ofthePDCAcycle.Whenthisprojectis
complete,
youwillfindaQIprojectinourdepartmenttolead.
May1
Inform
ation
manag
ement
Familiaritywiththe
standarddesktop;
understandingofd
ata
warehousing
Workwithanotherem
ployeetolearnthecalendara
ndwebsite
applications;usethec
alendartoscheduleallstaffm
eetings;use
thewebsitetoupdate
yourprofileandourmaininfopage.Meet
withourIScontactto
getanoverviewofthedatabackup/recovery
systemsandthesoftwareapprovalprocess.
May1
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arrive in healthcare after tenures in other industries. Those of us who are trained
and educated in the field can return the favor to these professionals by sharing our
knowledge of healthcare systems and providing opportunities for them to build
their own knowledge base.
Seeking mentors, and being a mentor. Getting to know people who have faced the
same challenges as our own and who have made mistakes along the way is helpful.
These people can guide managers so that they can avoid these mistakes. Based on
our experience, most healthcare leaders are generous with their time and expertise
when approached in the right way.
Of course, it is also very important to pay forward the kindness of people
who have more expertise than we do. Making ourselves accessible to new leaders
and managers is an essential part of our role as healthcare administrators and will
help us ensure that the powerful tradition of mentoring in our profession remainsavailable for the next generation of leaders.
The challenges of learning the complexities of the healthcare environment
relate to another HLA competency areaknowledge of the healthcare environment.
This competency will be the focus of the next column.
N o t e1. The full HLA competency model is available as a downloadable database. See
http://www.healthcareleadershipalliance.org/directory.cfm.
For more information on the concepts in this column, please contact AndyGarman at andy n [email protected].
Photocopying and distributing this PDF of the Journal of
Healthcare Management is prohibited without the permission of
Health Administration Press. For permission, please fax your
request to (312) 424-0014 or e-mail [email protected].